MISSOURI DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISION INSTRUCTIONS FOR MAKING YOUR FOOD STAMP APPLICATION & FOOD STAMP RIGHTS
To help you complete the Food Stamp application, we are providing the following information. If you have questions about this information, please contact the Family Support Division (FSD) Information Center at 1-855-FSD-INFO (1-855-373-4636).
FILING AN APPLICATION
Your date of application is the date the application is received in the FSD office with your name, address and signature. You may file an application in person, by mail, by fax, or online through the Family Support Division Program Enrollment website at www.dss.mo.gov
WE CANNOT ISSUE ANY FOOD STAMP BENEFITS TO YOU UNTIL THE APPLICATION FORM IS COMPLETED, SIGNED, RETURNED TO THE FSD OFFICE WITH PROOF OF YOUR IDENTITY, AND AN INTERVIEW HAS TAKEN PLACE.
If you qualify for emergency help, FSD must have proof of your identity before issuing Food Stamp benefits. Send proof of your identity with your application if you are mailing or faxing the form to the office. Or, bring a document into the office with your application.
COMPLETING THE APPLICATION FORM
Complete all the blanks on the application form. YOU MUST sign the first page and the last page of the application under “Signature”. If you are returning your application by mail, fax, or online through the Family Support Division Program Enrollment website, be sure to write a phone number on the application so we can call you for any additional information needed to finish your application. Tell us the best time to talk with you. (If you do not have a telephone or prefer, you can call us a few days after you mail or fax the form.) We must talk with you to conduct an interview.
FORMS
Below is a list of the forms that may be sent to you and information on how to fill them out. If you cannot complete the forms or you do not understand the questions, contact the FSD office for assistance.
1. APPLICATION FOR BENEFITS (FS-1): Write your name, address, names of individuals who reside with you, and the entire household's identifying information. Sign your name on the first and last pages. RETURN THE COMPLETED FS-1, APPLICATION FOR FOOD STAMP BENEFITS; THE FA-520, NOTICE OF EXPIRATION OF FOOD STAMP BENEFITS; AND APPLICABLE VERIFICATION(S) TO THE FAMILY SUPPORT DIVISION OFFICE OR CUSTOMER SERVICE CENTER.
BE SURE TO ANSWER ALL THE QUESTIONS ON THE APPLICATION. IF YOU ARE NOT RECEIVING FOOD STAMPS AT THIS TIME, A DETERMINATION WILL BE MADE REGARDING YOUR ELIGIBILITY FOR EXPEDITED FOOD STAMP BENEFITS WHEN YOUR COMPLETED APPLICATION IS RECEIVED IN THE OFFICE.
YOU KEEP: • Any informational leaflet; and • This letter of instruction, IM-31F
ON THE NEXT PAGE OF THIS FORM ARE EXAMPLES OF DOCUMENTATION OR VERIFICATION WHICH MAY BE NEEDED IN ORDER TO COMPLETE YOUR APPLICATION. PLEASE PROVIDE VERIFICATION OF ITEMS THAT APPLY TO YOU. THE FSD ELIGIBILTY SPECIALIST WILL RETURN THE ITEMS TO YOU. OTER REGISTRATION APPLICATION
VOTER REGISTRATION APPLICATION
A voter registration application has been included. If you wish to register to vote, please complete the form and return to the FSD office. This has no impact on your application or continued eligibility for assistance.

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INFORMATION NEEDED

Listed below are examples of the most common sources of verification used to determine your eligibility. If you have other documents or verification, discuss these items with the eligibility specialist. The eligibility specialist may also need the name, address, and phone number of a reference who can verify your statements.
IDENTITY
Identity must be verified for the head of household who is applying for Food Stamp benefits. Some examples of verification are: Driver’s license Photo identification card Other papers that verify your identity Social Security Card Birth certificate
RESIDENCE
To apply for Food Stamps, you must be a resident of Missouri. Verification of residence can be:
Rent or mortgage receipts Mail addressed to you Utility receipts References contacted
RESOURCES
Verification of resources may not be required. Your eligibility specialist will notify you if verification of resources is needed. Resources include money you may have, such as:
Bank accounts Lump sum payments Boats Farm equipment (out of use more than 12 months) Savings bonds Credit Union accounts Campers Property you own such as real estate other than Stocks Money owed to you Airplanes your home Certificates of Deposit (CDs) If needed, verification documents can be: Copies of bank statements Copies of deeds or purchase agreements Copies of CDs, stocks and/or bonds
INCOME
Income includes, but is not limited to, salary you receive as an employee or money you earn as a self-employed person. This includes, but is not limited to: Job Baby-sitting Odd jobs Temporary work Farming Income also includes benefits you receive, such as: Social Security/SSI Temporary Assistance Veteran’s benefits Child support or alimony Unemployment or Worker’s Compensation Documents to verify income may include:
Wage stubs Award letters from Social Security Administration, or Veteran’s Administration Divorce Decree For self-employment income, verification includes a current tax return, records of money received and expenses paid Copies of child support checks Check stub for Unemployment Compensation benefits or Worker’s Compensation checks
DEDUCTIBLE EXPENSES
Shelter expenses and child care expenses may not require verification. Your eligibility specialist will notify you if verification of these expenses is needed. A deductible expense for Food Stamps includes the following: Housing costs such as rent or mortgage payments Utility costs such as electricity, gas, water, sewer, trash, telephone, real estate taxes, or homeowner’s insurance Dependent care or child care costs, including transportation to and from the day care provider Child Support paid to non-household members Medical expenses are deductible if you, or any member of your household age 60 or over, or disabled, pay for the expense. These can be:
Prescription medicine	Dental care
Costs of doctor visits	Medical supplies
Health insurance	Costs of dentures
Medicare premiums	Glasses
Transportation to the doctor	Hearing aids
DSS PRIVACY POLICY
ATTENTION: Federal regulations require that the Missouri Department of Social Services (DSS) maintain a publicly available "Notice of Privacy Practices" that describes our policy for handling protected health information. The department has implemented a privacy policy and prepared a Notice of Privacy Practices. You may obtain a copy of this notice on the DSS Web site at http://www.dss.mo.gov/hipaa/hprivacy.pdf or from any DSS office.

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YOUR RIGHTS AS A FOOD STAMP APPLICANT/PARTICIPANT

You or someone you send always has the right to apply for Food Stamp benefits the day you contact ANY Family Support Division (FSD) ) office in person, by faxing the application or applying through the Family Support Division Program Enrollment website at www.dss.mo.gov. A Food Stamp application will be mailed to you the day you call the FSD office. You can mail the application back to the FSD office, fax it, or bring it in person to a FSD office. When applying for Food Stamp benefits, you can also apply for other help such as Medical Assistance, Temporary Assistance (cash assistance), or Child Care assistance at the same time. Or, you can apply just for Food Stamp benefits. If you file a joint application for Food Stamps and another assistance program and you are ineligible for the other assistance program, your Food Stamp application will not be denied solely on the basis that the other assistance was denied. The Food Stamp Program does not have time limits like Temporary Assistance does. Receiving Food Stamp benefits does not affect whether you are eligible to receive Temporary Assistance. If you lose your eligibility for Temporary Assistance because you go to work, meet your time limits, or for some other reason, you may still be eligible to receive Food Stamp benefits. You will need to be interviewed in person or by phone before your application can be completed. When your Food Stamp benefits are ending, you will receive a notice and a Food Stamp application in the mail. Fill it out, mail, fax, or bring the application in person to a FSD office or complete an application online through the Family Support Division Program Enrollment website. It is important that you let us know about any expenses you may have because you could be eligible for more Food Stamp benefits based on these expenses. Any expenses not reported will not be used to compute your Food Stamp benefit amount. You may be eligible to receive “expedited” or emergency Food Stamp benefits in 7 days. Otherwise, we will process your application in 30 days. To receive Food Stamp benefits for everyone in your household, you must give FSD each person’s Social Security Number. We will use the Social Security Number to: get information about each person from the Social Security Administration, IRS, Mo. Division of Workforce Development, Mo. Dept. of Corrections, Veterans Administration (VA), Division of Child Support Enforcement, local law enforcement, employers, etc., find out whether you are already receiving benefits in Missouri or from another state. If you do not want to give us the Social Security Number for someone in your household, the remaining household members may be eligible to receive Food Stamp benefits, without including those persons. To receive Food Stamp benefits for everyone in your household, you must give FSD the immigration status for any non-citizen in your household. If you do not want us to check on your immigration status or the immigration status of anyone else in your household, you can decide not to apply for Food Stamps for yourself or for any other person in your household. This may cause you to be ineligible for Food Stamps or to be eligible for a lower amount of Food Stamp benefits than you would get if you apply for everyone in your household. The staff of the Family Support Division is committed to quality customer service: You have the right to see or get copies of anything in your case file and have the papers explained to you in a language you understand. You have the right to a fair hearing if you disagree with any decision or action made on your case, if you are denied Food Stamps, or Food Stamp benefits are reduced. You have the right to talk to and bring a lawyer, a friend, a relative, or anyone else to a hearing on your case. You have the right to be treated fairly. Statement of Nondiscrimination The U.S Department of Agriculture also prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination with USDA, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). For any other information dealing with Supplemental Nutrition Assistance Program (SNAP) issues, persons should either contact the USDA SNAP Hotline Number at (800) 221-5689, which is also in Spanish or call the State Information/Hotline Numbers (click the link for a listing of hotline numbers by State); found online at http://www.fns.usda.gov/snap/contact_info/hotlines.htm. To file a complaint of discrimination regarding a program receiving Federal financial assistance through the U.S. Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200 Independence Avenue, S.W., Washington, D.C. 20201 or call (202) 619-0403 (voice) or (800) 537-7697 (TTY). USDA is an equal opportunity provider and employer.

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